Provider Demographics
NPI:1366859688
Name:CROSSLIN, GARY DALE (CADCA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DALE
Last Name:CROSSLIN
Suffix:
Gender:M
Credentials:CADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 VESPER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2851
Mailing Address - Country:US
Mailing Address - Phone:818-997-0414
Mailing Address - Fax:818-785-3461
Practice Address - Street 1:6166 VESPER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2851
Practice Address - Country:US
Practice Address - Phone:818-997-0414
Practice Address - Fax:818-785-3461
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)